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A surgeon in blue scrubs with blue gloves, who is masked and prepared for surgery, is handling a Veteran's foot in an operating room.

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High-risk Eye and Limb Preservation Program (HELPP)

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HELPP increases access to podiatry basic foot care services for patients who are at increased risk for amputation by embedding intermediate care technicians (ICTs) into rural VA clinics. This reduces the travel burden for patients who are rurally located and ensures consistent, routine podiatry care. Because ICTs are versatile, other health care components are built into these patient visits, including assessment for diabetic footwear and eye screening, making this a convenient, one-stop shop for Veterans.

This innovation is replicating across multiple facilities as its impact continues to be validated. See more replicating innovations.

Adoptions:

6 successful, 10 in-progress

Awards and Recognition:

2024 VHA Innovation Ecosystem Entrepreneur in Residence Fellowship

A surgeon in blue scrubs with blue gloves, who is masked and prepared for surgery, is handling a Veteran's foot in an operating room.

Tags:

Access to Care Home Health Outpatient Care Rural Health VHA IE Fellowships
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Overview

Problem

Many rural and highly rural Veteran patients who are at increased risk of lower limb amputation don’t have access to podiatry services. Basic foot care services (nail and callus cutting) are a critical, preventative care that patients need to maintain good foot health. In the absence of this service, nails become overgrown and calluses will cause excess pres ... See more

Images

An intermediate care technician with short black hair, black rimmed glasses, and a blue surgical mask, wearing grey-green scrubs and teal gloves is taking the temperature of a Veteran's foot with a handheld thermometer.

An Intermediate Care Technician (ICT) provides routine foot care to a Veteran enrolled in HELPP

Solution

The High-risk Eye and Limb Preservation Program (HELPP) deploys intermediate care technicians (ICTs) to rural areas to provide basic foot care services (nail cutting and callus cutting) and eye screenings to Veteran patients who are geographically rural or highly rural. This is done using virtual care, where a remote podiatrist observes the visits supervises ... See more

Images

An intermediate care technician with short black hair, black rimmed glasses, and a blue surgical mask, wearing grey-green scrubs and teal gloves is clipping the toenails of a Veteran

ICT providing routine footcare for Veterans

Results

Since 2020, HELPP has improved the amputation ratios by more than 40%, decreased community care utilization by more than 60% and improved access to care. Wait times at the main facility in Atlanta have decreased from 38 days to 10 days.

Diffusion tracker

Does not include Clinical Resource Hubs (CRH)

Statuses

GA: Covington VA Clinic (Covington, Georgia) GA: Fort McPherson VA Clinic (Fort McPherson) GA: Joseph Maxwell Cleland Atlanta VA Medical Center (Atlanta, Georgia) GA: Stockbridge VA Clinic (Stockbridge) IN: Scott County VA Clinic (Scott County)
  • Started adoption on 02/2026.
TN: Cookeville VA Clinic (Cookeville)
  • Started adoption on 10/2025.

AL: Wiregrass VA Clinic (Wiregrass)
  • Started adoption on 10/2026.
KY: Carrollton VA Clinic (Carrollton, Kentucky)
  • Started adoption on 10/2025.
NC: Cherry Point VA Clinic (Cherry Point)
  • Started adoption on 10/2026.
NC: Clayton-East Raleigh VA Clinic (Clayton East Raleigh)
  • Started adoption on 10/2026.
NC: Morehead City VA Clinic (Morehead City)
  • Started adoption on 10/2026.
OK: Blackwell VA Clinic (Blackwell)
  • Started adoption on 10/2026.
OK: Enid VA Clinic (Enid)
  • Started adoption on 10/2026.
OK: Shawnee VA Clinic (Shawnee, Oklahoma)
  • Started adoption on 10/2026.
OK: Stillwater VA Clinic (Stillwater)
  • Started adoption on 10/2026.
TX: South Enterprize VA Clinic (South Enterprize)
  • Started adoption on 10/2025.

There are no unsuccessful adoptions for this innovation.

Implementation

Departments

  • Podiatry

Core Resources

Resource type Resource description
PEOPLE
  • Podiatrist
  • 2 Intermediate Care Technicians (ICTs) per Podiatrist
PROCESSES
  • Training for ICTs in basic foot care (nail and callus care, basic wound care), diabetic shoe measuring and eye screening, competencies are defined both by TMS #28493 and National ICT program
TOOLS
  • Salary and supervisory management for ICTs and Podiatrists
  • Post and selection of podiatrists/ICTs
  • Disposable instrumentation
  • Administrative Support: working with local staff to build clinics, create consult templates and complete the Telehealth service agreements (TSA), clinic cancelations, OPPE and performance evaluations of providers, etc.
  • Telehealth equipment (CAS cart or webcam with extender)

Contact

Comment

Comments and replies are disabled for retired innovations and non-VA users.

VA User (Registered Nurse) posted

I am hoping this will soon be adopted in our VISN.

1
VA User (Certified Registered Nurse Anesthetist, RICVAMC) posted

Great work! Keep plugging away, good things take time!!

Email

Email with questions about this innovation.

About

Origin story

HELPP was initially created at the Atlanta VAHCS in response to the Covid-19 pandemic in 2020. Because of the success demonstrated by the program, it was supported by the VHA Innovation Ecosystem to scale and replicate in an effort to expand this resource to Veteran patients. Given the improved health outcome measures found with the program, the program rema ... HELPP was initially created at the Atlanta VAHCS in response to the Covid-19 pandemic in 2020. Because of the success demonstrated by the program, it was supported by the VHA Innovation Ecosystem to scale and replicate in an effort to expand this resource to Veteran patients. Given the improved health outcome measures found with the program, the program remained permanent and is being offered nationally through Office of Rural Health Enterprise Wide Initiative (ORH EWI) funding which began in 2025 as a way to spread podiatry BFC services nationwide.  

Original team

Nichol Salvo

National Podiatric Medical Director, Podiatry Program Office, Specialty Care Program Office, VACO

Sherrill Murad, DPM

HELPP, National Program Manager

Ashley Willis, DPM

HELPP, Program Lead

Search tags

Access to Care Home Health Outpatient Care Rural Health VHA IE Fellowships